Ageing successfully

Couple on Beach

According to the World Health Organization (WHO), life expectancy and medical advances has lengthened lifespans in most countries, and the number of people aged 60 years and older has doubled since 1980. Living longer is easy, with the advances we’re making in the domain of science and medicine. But we’re probably more interested in answering the question of how we can age successfully. That and avoiding dementia.

On this International Day of Older Persons, let’s review what’s been known for a while:

1. Eat your veggies!

There’s no getting away from it. Studies show that those who live a long independent life in Okinawa eat lots of fruits and vegetables, as well as fish and whole-grains. Their habit of eating until they feel 80% full is also likely a major contributor to the reason for their disability-free longevity.

2. Stay active!

Research indicates that cardiovascular disease risk is a major contributor to Alzheimer’s and vascular dementia (Fratiglioni et al., 2004). Lowering this risk through regular, weekly moderate-to-vigorous exercise is one strategy. And also a reason why Sardinians, who herd sheep over steep hills, are reputed to age successfully (see this TED video about the blue zones).

3. Engage your social brain!

A review of the literature shows that adults who are socially active are also likely to have better psychological wellbeing in their later years; being engaged in social activities and having stronger social networks is a protective factor against dementia (Fratiglioni et al., 2004). Various studies show that religious attendance, community involvement, and being employed are associated with better mental wellbeing among older adults. These activities are also shown to be helpful for local residents too…

So to sum, it’s the same thing that us active younger (a little bit younger) adults need to start doing. But we just need to keep doing them!

Caregiving: It’s a thankful job

World Elder Abuse Day

The World Health Organization defines dementia as a syndrome in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities. It is not considered part of normal ageing, but affects a substantial number of older adults. The Statistical Appendix from the local Alzheimer’s Disease Association put the number of locals with dementia at 22 for every 1000 persons in the year of 2005.

The multidimensional response to the negative appraisal and perceived stress resulting from taking care of an ill individual (Kim et al., 2011) does however negatively affect those tasked with looking after the care recipient. This caregiver burden puts strain and stress particularly on those in full or part-time employment.

And caregivers aren’t necessarily only those who do this job fulltime. There are more caregivers out there than you think. A 2011 Singstat Singapore Newsletter article reports that almost 75% of respondents providing regular assistance to friends or family in 2010 were also working adults who juggle work with caregiving responsibilities.

Given that research has shown that caregiver stress increases with the physical dependency of the care receipient, it’s all the more important that caregivers are equipped with the right knowledge. Kua and Tan in a 1997 study (see also Mehta, 2005) found that those who looked after care receipients with dementia tended to experience a high level of stress. And according to WHO, this is a pattern observed in other communities as well.

But the mental health of caregivers is often overlooked. Although various organisations like the US Family Caregiver AllianceTouch Caregivers, Singapore Caregiving Welfare Association, Women’s Initiative for Ageing Successfully, Council for the Third Age, Asian Women’s Welfare Association, Tsao Foundation and Singapore Family Caregivers, have useful self-care tips, caregivers typically do not seek help for themselves.

So we may need to play our part and help someone we know and care about. The American Psychological Association (APA) suggests a self-assessment instrument which was designed by the American Medical Association.

So on this World Elder Abuse Awareness Day, help that person you know take a step in the right direction. Get him or her to assess his or her stress levels, which will ultimately protect himself or herself from being burnt out as a caregiver!

Autism: Facts and Tips

autism updates

Autism is a developmental disorder which leads to difficulties with verbal and nonverbal communication, with social interactions, and with understanding and predicting other people’s intentions and behaviours. On this Autism Awareness Day, it’s important that we know the facts:

1. The cause for autism is as yet unknown.

2. Not everyone who has autism has a special talent like that of Raymond in Rain Man (1988).

3. Autism can be diagnosed in early childhood. 

4. More boys than girls are diagnosed with autism.

5. There are support groups for families of individuals with autism.

6. It’s important for parents to receive emotional support as well.

Majong is good for you

That majong is good for us is music to our ears (well, at least for some of us who actually play majong). The claim is based on recent research findings, which has led to reports that “tai chi, majong offer hope for dementia patients” (South China Morning Post, 22 April 2013; see also a similar report in www.majongnews.com).

The evidence is based on two studies. The first showed that a 3-times-a-week programme of either tai chi or majong for 12 weeks was significantly more effective in reducing depression scores among older adults with mild dementia and moderate depression in nursing homes than a handicraft control condition (Cheng et al., 2011). The second showed that the same programme was effective in improving cognitive task performance for a sample of 110 participants with the same population characteristics (Cheng et al., 2012); the first study sampled 12 participants for each condition. It’s not the case that the findings are limited to only nursing residents because these results replicate an earlier finding by Cheng and colleagues. Their 2006 study found that playing majong twice or four times a week for a duration of 16 weeks improved the cognitive performance of 62 older adults living in the community.

Although it would appear that playing majong is helpful in protecting against dementia, it would be wise to also observe that the participants in the 2006 study had not played (although they knew how to play) the game for at least 6 months prior to the study. Similarly, nursing residents were also not regularly practising tai chi or playing majong on a regular basis before the intervention programme was implemented. That is to say, there may be some benefit initially of engaging in mentally challenging activities, but at some point the cognitive demand of these activities may not be sustained over the longer term.

So the advice is to provide your brain with opportunities to grow new neural connections. Giving yourself cognitively demanding tasks like mastering a new language, musical instrument, skill, dance, game, or exercise form, serves this purpose. Learning to play a mentally challenging game like Chinese or international chess, weiqi, taboo, scattergories, and majong for the first time will definitely put us out of our comfort zone. But with a little practice (or a lot for strategy games), it likely loses its edge in its ability to build cognitive reserves and its protective cloak against Alzheimer’s disease. If you’re feeling comfortable, whatever you’re doing is not likely to be of extra benefit. If you’re feeling the strain on your brain, you should keep doing it (at least for a while).

Learning is important. But what’s crucial is that we keep levelling up.

10 Things To Know About Caregiving

The current ratio of adults aged 20 to 64 years to older adults aged 65 years and above is 6.4, according to the Department of Statistics Singapore, although a recent news article (“Fast-ageing Singapore, fewer to support aged; Trend worries experts”, The Sunday Times, 27 Sept 2013) put this figure at 5.5. Concerns about an ageing demographic aren’t solely a local concern. According to the facts and figures from WHO, life expectancy and medical advances make this issue in other countries too.

It should be pointed out that its entirely arbitrary that we should support someone at age 65 but not the year before. But nevertheless, ageing is a pressing issue. Consequently, ageing issues receive much media attention, with recent special reports such as those listed below, putting the spotlight on caregivers.

While it’s reassuring to know that one isn’t alone in the sandwich generation of being a parent of young (and not-so-young) children and being a caregiver of parents (and for some, siblings), it may be useful to have the resources one needs or will eventually need, when caregiving needs arise.

As full-time employees, we may be only part-time caregivers, but we are still caregivers in some capacity or other nonetheless. Given that the mental wellbeing of caregivers is important, here’s 10 things you should know about caregiving:

  1. Most caregivers in Singapore are employed. You’re not alone.

    According to a 2010 survey, almost 75% of individuals who said they provided regular assistance to friends or family were employed (Singstat Singapore Newsletter, Sept 2011). That means that many caregivers endeavor to manage their time between work, caregiving and others responsibilities at the home.

  2. Caregivers may experience high levels of stress.

    Research shows that caregiver stress increases with the physical dependency of the care receipient. As reported in a 2007 NCSS Social Service Journal, research shows that care receipients who have lower scores on Activities of Daily Living tend to have caregivers who experience higher levels of stress (Mehta & Joshi, 2001). Specifically, those who look after care receipients who have dementia tend to have high levels of stress (Kua & Tan, 1997). Don’t be surprised when this turns up as one of the WHO’s 10 Facts About Dementia!

  3. There are many resources available for caregivers. Several local organizations also have online caregiving resources.

    These include among others: a fact sheet about dementia (WHO), the 10 early warning signs (Alzheimer’s Association), books on coping with caregiver emotions and stress from the US National Institute of Aging, useful tips and facts for caregivers from the US Family Caregiver Alliance. 

  4. Touch Caregivers Support

    Touch Caregivers Support provides useful Caregiver Tips, runs courses and talks, and counselling services. Their website also has resources in Chinese.

  5. Caregiving Welfare Association

    The Caregiving Welfare Association has an free online counselling service for caregivers providing care to older adults with physical or mental disabilities, where caregivers are residents of Singapore and above 18 years of age.

  6. WINGS

    WINGS organizes regular exercise programmes, talks and workshops, and other activities to support women in ageing successfully.

  7. Council for the Third Age

    Council for the Third Age has resources for helping seniors with lifelong learning. Modules include resources for tech topics, library resources, recommended reading and videos. 

  8. AWWA

    Caregivers Connect is a community network for caregivers by caregivers through events organised each quarter and on online forums. Other services offered by AWWA include a Caregiving Life Skills Training programme.

  9. Tsao Foundation

    The Tsao Foundation has caregiving resources on caring for the frail, looking after your emotional wellbeing and physical health, and financial security, as well as information about TCM and acupuncture.

  10. SG Family Caregivers

    Information about caregiver stress is also available at Singapore Family Caregivers’ website.